title: Experience of the transplant team is an important factor for posttransplant survival in patients with hepatocellular carcinoma undergoing living-donor liver transplantation.
abstract: Living-donor liver transplantation (LDLT) is an effective treatment for patients with unresectable hepatocellular carcinoma (HCC). However, it remains controversial whether expanded listing criteria can be used for LDLT. We aimed to review results of LDLT for patients with HCC at our center. Patients with HCC were accepted for LDLT if there was no extrahepatic spread on computed tomography (CT) and positron emission tomography CT scan. Transarterial chemoembolization was performed before LDLT to control the tumors. Sirolimus or everolimus was used as part of the immunosuppressive protocol for all patients. Over the last 6 years, 35 of the 102 (34%) LDLT were performed at our center for HCC. Age (mean +/- SEM) was 55.3 +/- 1.3 years; 28 patients (80%) were men. Eight (23%) had LDLT performed in 2002 or 2003 (period 1), and 27 (77%) in 2004 to 2007 (period 2). Eleven (31%) were within and 23 (69%) were outside the Milan criteria. After 583 +/- 76 days follow-up, nine (25%) died, three of recurrent HCC. Three-year survival was significantly better in period 2 than in period 1 (90% vs 13%; P < .001). Although the 3-year survival for those within Milan criteria was better than those outside Milan criteria, the difference did not reach statistical significance (86% vs 57%; P = .26). Six (17%) had HCC recurrence, of whom five died. We concluded that reasonable medium-term survival can be obtained for patients with HCC. The experience level of the transplant team seemed to be the most important predictor of patient outcome.
authors.affiliation: Asian Center for Liver Diseases and Transplantation, Singapore.
authors.forename: T A
authors.initials: TA
authors.lastname: Majeed
authors.forename: C T
authors.initials: CT
authors.lastname: Wai
authors.forename: H
authors.initials: H
authors.lastname: Rajekar
authors.forename: K H
authors.initials: KH
authors.lastname: Lee
authors.forename: S Y
authors.initials: SY
authors.lastname: Wong
authors.forename: S O
authors.initials: SO
authors.lastname: Leong
authors.forename: R
authors.initials: R
authors.lastname: Singh
authors.forename: K H
authors.initials: KH
authors.lastname: Tay
authors.forename: J
authors.initials: J
authors.lastname: Chen
authors.forename: K C
authors.initials: KC
authors.lastname: Tan
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D019694:Hepatitis B, Chronic / Q000150:complications / Q000601:surgery; D019698:Hepatitis C, Chronic / Q000150:complications / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D019520:Living Donors; D008875:Middle Aged; D010348:Patient Care Team / Q000592:standards* / Q000706:statistics & numerical data; D018579:Patient Selection; D011184:Postoperative Period; D017741:Survivors; D013997:Time Factors